MEDICARE: INTERMED SERVICES, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	ME0075961	FL

General Provider Information

NPI Number	:	1013209980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERMED SERVICES, PA

Provider Business Mailing Address
First Line	:	PO BOX 10694
Second Line	:
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33419-0694
Country	:	US
Telephone Number	:	561-845-2081
Fax Number	:	561-845-2953

Provider Business Practice Location Address
First Line	:	1115 45TH ST
Second Line	:	SUITE 1A
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2376
Country	:	US
Telephone Number	:	561-845-2081
Fax Number	:	561-845-2953

Authorized Official
Title or Position	:	CEO
Name	:	DR. SHAHEED KALLOO
Credential	:	M.D.
Telephone Number	:	561-845-2081

Provider Enumeration Date	:	05/10/2011
Last Update Date	:	05/10/2011

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